By and For Those With Private Disability Claims

Prudential – Tricks, Ignornace and “We Never Got It”

Prudential Life Insurance Company has been using the same old trick to deny claims it has used for the last 8 years, at least that I know of.

Prudential’s major product is integrated STD/LTD employer group plans. Short-term disability is generally maxed out at 26 weeks and LTD immediately begins thereafter. Although STD is normally automatic with updated medical at 2-week intervals, Prudential has been engaging in a deliberate strategy to consistently deny LTD benefits, a more long-term and expensive liability to the company.

Here’s the way it works. Prudential pays the STD claim but not to the maximum duration of 26 weeks. Instead, the company will pay perhaps 24-25 weeks and then deny the remainder of the STD benefit right in the middle of the Elimination Period of the LTD claim.

Then, the company not only denies the last two weeks of STD, but also LTD benefits as well. The justification for the LTD denial is always the claimant was not disabled during the LTD Elimination Period. A very, very clever unfair claims practice.

I want to point out that anytime a disability insurer deliberately and consistently engages in the same claims practice over a period of time, it becomes a “pattern of business practice” and it could be construed as illegal, or racketeering. Prudential has been using the same “old trick” for quite some time and apparently doesn’t care who picks up on it.

In one instance Prudential denied STD benefits to a claimant in the 25th week of STD. My client’s argument to the company was “what could possibly have changed medically from the 25th to the 26th week of STD benefits?” The answer is obvious – nothing changed medically, however, had Prudential paid the claim for an additional week, it would have had to pay the LTD benefits.

I think I should drive this home and make sure everyone clearly understands the trick. Both the STD and LTD claims have elimination periods. An elimination period is usually 90 days for LTD and it is a period of time beginning with the date of disability and ending on the 90th day. Benefits are payable then on the 91 st day.

Prudential, however, denies the STD claim somewhere in the EP for the LTD benefits because STD benefits and the LTD elimination period often overlap by several weeks. Then, Prudential claims in the denial letter the LTD claim is also denied because the claimant didn’t meet the 90 elimination period for LTD.

It’s like clock-work and Prudential uses the same “ol’trick” time and time again. Most claimants who contact us describe the same claims practice which denies LTD in the above fashion. Prudential has been doing this for a long time.

Also, claimants tell us Prudential claims specialists are not the sharpest knives in the drawer these days and seem to know little about the claims process or disability policies. It’s very hard to get accurate answers to questions when the claims specialist isn’t well trained. Prudential just doesn’t seem to be putting much money or effort in training its claims staff to handle complex claim situations. You can’t reason with someone who doesn’t know anything and it’s frustrating for claimants who try.

Those of you who have Prudential claims probably noticed its letters never seem to answer questions, or tell you very much. In fact, Prudential’s written communications are re-hashes of policy provisions over and over again. Everytime I read a Prudential letter I think about responding “we get it, we get it!”

Very seldom have I read a Prudential letter that actually resolved any claims issue or didn’t repeat policy provisions over and over again. There is a place and time for an insurer to do that but not at the expense of doing it everytime and not addressing the issues.

Last but not least – Prudential never seems to actually get much of the paperwork and forms claimants fax or send to the company. This claims practice would be laughable if it were not so tragic. “I didn’t it – I didn’t get it – I didn’t get it…..Prudential claims handlers will tell you over and over again he/she never received the information you sent repeatedly. This is why DCS recommends sending all information by US Priority Mail with a signature confirmation. Or, if faxing, printing out a confirmation of receipt.

The fact that much of the paperwork faxed or sent to Prudential seems to end up in the perpetual ozone somewhere is an indication of internal negligence and most likely some degree of chaos in receiving paperwork and getting it to the proper claims handler.

However, Prudential employees will tell claimants over and over again, “We just didn’t get it.” The truth is Prudential did get it, but lost it in their chaotic internal “we don’t know anything” process of reviewing claims.

The key to dealing with Prudential is to force the company into accountability for what it says, denies, or loses. Know in advance you need to back up all of your paperwork and keep a journal diary listing every call, who you spoke to, what was said, what and when the paperwork was sent.

One thing claimants can always count on is that Prudential never seems to change or get any better. The company has always been a trickster and has lost more paperwork than the US government.

Knowing how the company dysfunctions going into the claims process is a step ahead in maintaining control of the process to protect the payment of legitimate benefits. Those of you with Prudential claims who have just nodded your way through this entire post know exactly what I’m talking about!